A comparison of healthcare resource utilization and costs between patients with chronic lymphocytic leukemia treated with first-line ibrutinib or acalabrutinib using two large US real-world databases.

Aim: Real-world evidence comparing healthcare resource utilization (HRU) and costs between ibrutinib and acalabrutinib, two Bruton's tyrosine kinase inhibitors for the treatment of chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL) is limited. Materials & methods: Commercial claims from IQVIA PharMetrics Plus and electronic medical records from Acentrus were used to separately evaluate HRU and costs in CLL/SLL patients initiating first-line (1L) single-agent ibrutinib or acalabrutinib on or after 21 November 2019 (index date). Imputed costs were used for Acentrus using previously published assumptions. Regression analyses adjusted for baseline characteristics were used to compare HRU and costs between ibrutinib and acalabrutinib during 1L therapy. Results: In IQVIA, 537 and 355 patients initiated 1L ibrutinib and acalabrutinib, respectively; in Acentrus, 710 and 373 patients initiated 1L ibrutinib and acalabrutinib, respectively. The mean duration of 1L (in years) was longer for ibrutinib (IQVIA: 1.2; Acentrus: 1.3) than acalabrutinib (IQVIA: 0.8; Acentrus: 0.9). The number of CLL/SLL-related outpatient visits were significantly lower for ibrutinib versus acalabrutinib (IQVIA: 0.86 vs 1.09 per-patient-per-month, rate ratio: 0.85, p = 0.018; Acentrus: 0.57 vs 0.74 per-patient-per-month, rate ratio: 0.80, p = 0.036). Using claims data for IQVIA and imputed costs for Acentrus, total all-cause costs (IQVIA: mean monthly cost difference [MMCD]: -$764, p = 0.279; Acentrus: MMCD: -$1355, p = 0.004) and CLL/SLL related costs (IQVIA: MMCD: -$649, p = 0.133; Acentrus: MMCD: -$1215, p = 0.004) were lower for ibrutinib versus acalabrutinib. Conclusion: In this large real-world study using a mix of claims data and imputed cost estimates, CLL/SLL patients treated with ibrutinib had longer duration of 1L, fewer days with CLL/SLL-related outpatient services and numerically lower all-cause and CLL/SLL-related costs versus acalabrutinib, showing that ibrutinib can be an optimal cost-effective option in 1L.